Midazolam

Pronunciation: mid-AY-zoh-lam.

Generic name: midazolam
Drug class: Benzodiazepine sedative
Form: Injection, nasal spray, oromucosal solution
Route: Injection, nasal spray, or oromucosal solution depending on the product
Legal status: Prescription-only; controlled-medicine rules vary by country and formulation

Prescription medicine; many products are for clinical use

Trade names by country: United States · United Kingdom · Canada · Australia · Nepal · New Zealand

Australia: Midazolam Viatris (8), Pfizer (Australia) Midazolam Injection (9) · Full directory

What midazolam is and how it works

Midazolam is a benzodiazepine that depresses central nervous system activity. It is used in supervised procedural or critical-care settings and, in some countries and formulations, as prescribed rescue treatment for seizure clusters or prolonged convulsive seizures. (1) (2) (3) (5)

The exact indication, route, dose, and monitoring depend on the individual product and country. This page does not give a universal dose or a self-treatment plan. Follow the specific prescription and product leaflet.

Mechanism of action: how midazolam works

Midazolam is a short-acting benzodiazepine with sedative, anxiolytic, amnestic, muscle-relaxant, and anticonvulsant effects. (1) (5)

What midazolam is used for

Procedural sedation

Injection may be used by trained clinicians before or during procedures or anaesthesia, with monitoring and resuscitation capability. (1) (2)

Critical-care sedation

Specific intravenous products may be used for sedation of intubated, mechanically ventilated patients in critical care. (1)

Prescribed seizure rescue

Certain nasal or oromucosal products are prescribed for specific seizure emergencies; caregivers need product-specific training and a seizure action plan. (3) (5)

Before taking midazolam

Do not take / not appropriate for

Do not use if you have had a serious allergy to midazolam, benzodiazepines, or product ingredients. (product-label dependent) (1) (5)
Do not use another person’s prescription or a different route/formulation as a substitute. (all countries) (3) (5)

Tell your clinician about

Breathing problems, sleep apnoea, heart, liver, or kidney disease.
All medicines, alcohol, opioids, sedatives, herbal products, and recreational drugs.
Pregnancy, breastfeeding, older age, frailty, or history of substance-use disorder.
Any prior paradoxical reaction to a benzodiazepine.

(1) (3) (5)

How to take midazolam

Use only exactly as prescribed or administered by trained healthcare professionals.
For a prescribed rescue product, ensure the caregiver follows the specific labelled instructions and seizure action plan.
Do not drink alcohol or take unapproved sedating medicines with midazolam.
Do not drive or operate machinery until fully recovered and your clinician says it is safe.

(2) (3) (5)

Procedures and hospital treatment

Injected midazolam requires trained staff, continuous appropriate monitoring, resuscitation drugs and airway equipment. Tell the team about every medicine and substance you have taken. (1)

Missed dose

Most injected uses are clinician-administered and rescue products are used only according to a plan. Do not take an extra dose or repeat a rescue dose unless your exact prescription or clinician instructs this.

All countries

Ask the prescriber or pharmacist for your product-specific missed-dose and repeat-dose instructions. (3) (5)

Overdose

Too much midazolam can cause extreme sleepiness, slowed or difficult breathing, coma, or death—especially with opioids, alcohol, or other sedatives. Call emergency services immediately if the person is difficult to wake or has breathing problems. (3) (1)

Side effects

Drowsiness and impaired coordination can occur. Respiratory effects are the key safety concern and require immediate action.

Drowsiness, memory or coordination problems

What to notice: Sleepiness, slowed thinking, unsteadiness, or temporary memory impairment.

What to do: Avoid driving, alcohol, and hazardous tasks until completely recovered. (2) (5)

Unusual agitation or behaviour

What to notice: Restlessness, agitation, involuntary movements, or unexpected behavioural change.

What to do: Seek medical advice promptly; urgent assessment may be needed. (2) (1)

Serious warnings

Breathing problems or unresponsiveness — emergency

Symptoms: Slow, shallow, difficult breathing; bluish colour; extreme sleepiness; inability to wake.

Action: Call emergency services immediately. (1) (3)

Opioids, alcohol, or other sedatives — emergency

Symptoms: Profound sedation or breathing problems may occur when combined.

Action: Do not combine unless the prescribing clinician specifically directs and monitors it. (1) (5)

Dependence and withdrawal — high caution

Symptoms: Stopping after repeated use can cause withdrawal, including seizures.

Action: Do not stop or reduce repeated use abruptly; obtain prescriber advice. (3) (1)

Interactions

Medicine or test	Effect	Action
Opioids, alcohol, and other CNS depressants	Can markedly increase sedation and respiratory depression.	Tell the clinician about all substances; avoid alcohol unless specifically advised. (1) (5)
CYP3A4 inhibitors or inducers	May increase or decrease midazolam exposure, depending on product and medicine.	A clinician or pharmacist must check the full medicine list before use. (5)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy and breastfeeding

Use requires individual clinical assessment; discuss urgently with the prescriber rather than stopping a needed seizure plan without advice. (5)

Liver, kidney, heart, or respiratory disease

Effects may be prolonged or breathing risk increased; product-specific clinician assessment is necessary. (1) (5)

Children and older adults

Age-specific products and monitoring requirements apply. Do not extrapolate another person’s dose. (1) (5)

Monitoring

Before starting

Confirm the exact product, indication, route, and seizure action plan where relevant.
Review opioids, alcohol, sedatives, CYP3A4 modifiers, comorbidities, and airway risk.

During treatment

Monitor alertness and breathing; in supervised injection settings, monitor respiratory and cardiovascular status.
After rescue treatment, follow the written escalation plan and seek emergency care when indicated.

(1) (3)

Storage

Keep prescribed rescue products in their original packaging, secured from children and others. Follow the leaflet for your exact product.

United Kingdom: Epistatus is stored in the original package to protect from light; do not refrigerate or freeze. (6)

Study the drug class: Benzodiazepines

Professional information

Clinician-facing context only. Use the exact local product label, local sedation protocol, controlled-medicine requirements, and seizure pathway.

All regions

Indication: Any midazolam use

Dose summary: No universal dose is displayed because dose and route vary by product, indication, patient factors, and monitoring setting.

Renal context: Consider renal, hepatic, respiratory, cardiac, frailty, and interacting-medicine context. (1) (5)

Mechanism of action

Hepatic guidance

Metabolism and exposure can be affected by hepatic impairment and CYP3A4 interactions; follow the exact product label.

Overdose note

Airway and ventilatory support are priorities in toxicity. Follow local emergency, toxicology, and product-specific guidance. (1) (5)

Frequently asked questions

What is midazolam used for?

midazolam is prescribed for approved indications. Always follow your healthcare provider's guidance.

What are the side effects of midazolam?

Common side effects may include gastrointestinal symptoms and headache. Serious side effects require immediate medical attention.

Can I take midazolam with other medications?

Always inform your healthcare provider about all medications you are taking, including over-the-counter products and supplements.

What is the mechanism of action of midazolam?